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Is There an Apparent Reason for These Cancer Recurrence Data?

Grobmyer, Stephen R. MD; Rice, Mark J. MD

doi: 10.1213/ANE.0b013e31827a0ae2
Letters to the Editor: Letters & Announcements
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Department of Surgery, University of Florida College of Medicine

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, mrice@anest.ufl.edu

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To the Editor

Results from the retrospective study by Lai et al.1 reporting a reduced risk of hepatocellular carcinoma recurrence after percutaneous radiofrequency ablation (PRFA) in patients receiving general anesthesia compared with those receiving regional anesthesia contradict a number of recent studies showing that regional anesthesia is associated with lower recurrence rates after breast,2 colon,3 and prostate4 cancer surgery.

We do note that Lai et al. discuss a previous report5 of PRFA performed under local anesthesia and comment that “Pain may force the physician to decrease the current intensity, to shorten coagulation duration, or to limit the number of overlapping coagulations.”1 We believe this may indeed account for the findings in the current study and suggest that the authors should have added, “For some cancer operations, regional anesthesia alone may not provide the best outcome from a surgical procedure.”

This report would not be the first to document that inadequate anesthesia may lead to a substandard cancer operation. In 1996, Papa et al.6 described the inability to achieve clear resection margins during lumpectomy for breast cancer surgery under local anesthesia (27.6%) compared with general anesthesia (7.3%). This explains why many breast surgeons prefer that patients receive general anesthesia when performing lumpectomy for breast cancer and may also be the principal reason that Lai et al. found a greater recurrence rate after PRFA in patients receiving epidural anesthesia than those receiving both epidural and general anesthesia.

Stephen R. Grobmyer, MD

Department of Surgery

University of Florida College of Medicine

Mark J. Rice, MD

Department of Anesthesiology

University of Florida College of Medicine

Gainesville, Florida

mrice@anest.ufl.edu

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REFERENCES

1. Lai R, Peng Z, Chen D, Wang X, Xing W, Zeng W, Chen M. The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma. Anesth Analg. 2012;114:290–6
2. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105:660–4
3. Gottschalk A, Ford JG, Regelin CC, You J, Mascha EJ, Sessler DI, Durieux ME, Nemergut EC. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology. 2010;113:27–34
4. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008;109:180–7
5. Kettenbach J, Köstler W, Rücklinger E, Gustorff B, Hüpfl M, Wolf F, Peer K, Weigner M, Lammer J, Müller W, Goldberg SN. Percutaneous saline-enhanced radiofrequency ablation of unresectable hepatic tumors: initial experience in 26 patients. AJR Am J Roentgenol. 2003;180:1537–45
6. Papa MZ, Klein E, Davidson B, Karni T, Sperber F, Koller M, Ravid M, Ben-Ari G. The effect of anesthesia type on needle localization breast biopsy: another point of view. Am J Surg. 1996;171:242–3
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